title: Adaptive support ventilation may deliver unwanted respiratory rate-tidal volume combinations in patients with acute lung injury ventilated according to an open lung concept.
abstract: BACKGROUND
  With adaptive support ventilation, respiratory rate and tidal volume (V(T)) are a function of the Otis least work of breathing formula. We hypothesized that adaptive support ventilation in an open lung ventilator strategy would deliver higher V(T)s to patients with acute lung injury.
  
  
  METHODS
  Patients with acute lung injury were ventilated according to a local guideline advising the use of lower V(T) (6-8 ml/kg predicted body weight), high concentrations of positive end-expiratory pressure, and recruitment maneuvers. Ventilation parameters were recorded when the ventilator was switched to adaptive support ventilation, and after recruitment maneuvers. If V(T) increased more than 8 ml/kg predicted body weight, airway pressure was limited to correct for the rise of V(T).
  
  
  RESULTS
  Ten patients with a mean (±SD) Pao(2)/Fio(2) of 171 ± 86 mmHg were included. After a switch from pressure-controlled ventilation to adaptive support ventilation, respiratory rate declined (from 31 ± 5 to 21 ± 6 breaths/min; difference = 10 breaths/min, 95% CI 3-17 breaths/min, P = 0.008) and V(T) increased (from 6.5 ± 0.8 to 9.0 ± 1.6 ml/kg predicted body weight; difference = 2.5 ml, 95% CI 0.4-4.6 ml/kg predicted body weight, P = 0.02). Pressure limitation corrected for the rise of V(T), but minute ventilation declined, forcing the user to switch back to pressure-controlled ventilation.
  
  
  CONCLUSIONS
  Adaptive support ventilation, compared with pressure-controlled ventilation in an open lung strategy setting, delivers a lower respiratory rate-higher V(T) combination. Pressure limitation does correct for the rise of V(T), but leads to a decline in minute ventilation.
authors.affiliation: Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.a.dongelmans@amc.uva.nl
authors.forename: Dave A
authors.initials: DA
authors.lastname: Dongelmans
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology* / Q000628:therapy*; D000704:Analysis of Variance; D001835:Body Weight; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D056152:Respiratory Rate; D013990:Tidal Volume